Journal article
Low hemoglobin levels are independently associated with neonatal acute kidney injury: a report from the AWAKEN Study Group
Pediatric research, Vol.89(4), pp.922-931
03/01/2021
DOI: 10.1038/s41390-020-0963-x
PMCID: PMC8730540
PMID: 32526767
Abstract
Background Studies in adults showed a relationship between low hemoglobin (Hb) and acute kidney injury (AKI). We performed this study to evaluate this association in newborns. Methods We evaluated 1891 newborns from the Assessment of Worldwide AKI Epidemiology in Neonates (AWAKEN) database. We evaluated the associations for the entire cohort and 3 gestational age (GA) groups: <29, 29-<36, and >= 36 weeks' GA. Results Minimum Hb in the first postnatal week was significantly lower in neonates with AKI after the first postnatal week (late AKI). After controlling for multiple potential confounders, compared to neonates with a minimum Hb >= 17.0 g/dL, both those with minimum Hb <= 12.6 and 12.7-14.8 g/dL had an adjusted increased odds of late AKI (aOR 3.16, 95% CI 1.44-6.96,p = 0.04) and (aOR 2.03, 95% CI 1.05-3.93;p = 0.04), respectively. This association was no longer evident after controlling for fluid balance. The ability of minimum Hb to predict late AKI was moderate (c-statistic 0.68, 95% CI 0.64-0.72) with a sensitivity of 65.9%, a specificity of 69.7%, and a PPV of 20.8%. Conclusions Lower Hb in the first postnatal week was associated with late AKI, though the association no longer remained after fluid balance was included. Impact
The current study suggests a possible novel association between low serum hemoglobin (Hb) and neonatal acute kidney injury (AKI). The study shows that low serum Hb levels in the first postnatal week are associated with increased risk of AKI after the first postnatal week. This study is the first to show this relationship in neonates. Because this study is retrospective, our observations cannot be considered proof of a causative role but do raise important questions and deserve further investigation. Whether the correction of low Hb levels might confer short- and/or long-term renal benefits in neonates was beyond the scope of this study.
Details
- Title: Subtitle
- Low hemoglobin levels are independently associated with neonatal acute kidney injury: a report from the AWAKEN Study Group
- Creators
- Arwa Nada - University of Tennessee Health Science CenterDavid Askenazi - University of Alabama at BirminghamLouis J. Boohaker - University of Alabama at BirminghamLinzi Li - University of Alabama at BirminghamJohn D. Mahan - Nationwide Children's HospitalJennifer Charlton - University of Virginia Health SystemRussell L. Griffin - University of Alabama at BirminghamAWAKEN Study Group
- Contributors
- Tarah T Colaizy (Contributor) - University of Iowa, NeonatologyJonathan M Klein (Contributor) - University of Iowa, Neonatology
- Resource Type
- Journal article
- Publication Details
- Pediatric research, Vol.89(4), pp.922-931
- Publisher
- Springer Nature
- DOI
- 10.1038/s41390-020-0963-x
- PMID
- 32526767
- PMCID
- PMC8730540
- ISSN
- 0031-3998
- eISSN
- 1530-0447
- Number of pages
- 10
- Grant note
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester UL1TR003096 / UAB's Center for Clinical and Translational Sciences (CCTS, NIH) Stony Brook Children's Hospital Department of Pediatrics fund Micah Batchelor Foundation Section of Pediatric Nephrology, Department of Pediatrics, Texas Children's Hospital Children's of Alabama Hospital U54TR001356 / University of Iowa Institute for Clinical and Translational Science 100 Women Who Care Canberra Hospital Private Practice Fund UL1TR001449 / Clinical and Translational Science Center (CTSC, NIH); United States Department of Health & Human Services; National Institutes of Health (NIH) - USA Edward Mallinckrodt Department of Pediatrics at Washington University School of Medicine Department of Pediatrics & Communicable Disease, C.S. Mott Children's Hospital, University of Michigan Cincinnati Children's Hospital Center for Acute Care Nephrology Department of Pediatrics, UAB School of Medicine
- Language
- English
- Date published
- 03/01/2021
- Academic Unit
- Stead Family Department of Pediatrics; Neonatology
- Record Identifier
- 9984354149802771
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